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General NPI Number Information
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NPI Number | 1275075061
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Entity Type | Organization
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Legal Business Name | SPECIALISTS IN GASTROENTEROLOGY
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 1710 N RANDALL RD SUITE 280
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City | ELGIN
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State | IL
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Zip | 60123-9400
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Country | US
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Telephone | 847-931-7550
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Fax | 847-931-0876
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Provider Business Mailing Address
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Address Line | 1710 N RANDALL RD SUITE 280
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City | ELGIN
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State | IL
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Zip | 60123-9400
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Country | US
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Telephone | 847-931-7550
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Fax | 847-931-0876
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEEPAK KHURANA
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Credential | M.D.
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Telephone | 847-931-7550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209014800
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License Number State | IL
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